ABSTRACT ? ? Medical and surgical care is fraught with hazards, particularly in low and middle income countries (LMICs). Powerful institutional wide processes to improve health safety have come from high reliability organizations (HROs) which have advocated adoption of a ?culture of safety,? which is the shared values, attitudes, perceptions, and patterns of behavior that determine the effort with which staff direct their attention towards minimizing patient harm. Measures of staff perceptions about safety culture?termed the ?safety climate?? are critical to develop quality improvement efforts. Our overall goal?is to improve surgical safety for children by building a safety culture in resource constrained settings. Following measurement of the safety climate at two ? pediatric units in two public hospitals in Guatemala using a low cost, standardized, electronic survey tool, we will assess the implementation of the SCORE safety program at these two units. Our research team is a public private partnership (PPP) composed of Guatemalan hospital leadership, U.S. academic experts, and social entrepreneurs from a private U.S. patient safety organization.